@article{16597,
  author = {Gao P. and Mann J. and Matsushita K. and Ninomiya T. and Levey Andrew and Levey Andrew and El-Nahas M. and Eckardt K. and Kasiske B. and Hemmelgarn B. and Sacks F. and Curhan G. and Collins A. and Chen S. and Cohort K. and Lee B. and Ishani A. and Neaton J. and Svendsen K. and Nelson R. and Knowler W. and Bilo H. and Joosten H. and Kleefstra N. and Groenier K. and Auguste P. and Veldhuis K. and Camarata L. and Thomas B. and Manley T. and van der Velde Marije and Woodward Mark and Wang A. and Yusuf S. and Li S. and Astor B. and Teo K. and Coresh J. and de Jong P. and de Jong P. and Gansevoort R. and Tonelli M. and Chalmers J. and Macmahon S},
  title = {Lower estimated glomerular filtration rate and higher albuminuria are associated with all-cause and cardiovascular mortality. A collaborative meta-analysis of high-risk population cohorts},
  abstract = {<p>
Screening for chronic kidney disease is recommended in people at high risk, but data on the independent and combined associations of estimated glomerular filtration rate (eGFR) and albuminuria with all-cause and cardiovascular mortality are limited. To clarify this, we performed a collaborative meta-analysis of 10 cohorts with 266,975 patients selected because of increased risk for chronic kidney disease, defined as a history of hypertension, diabetes, or cardiovascular disease. Risk for all-cause mortality was not associated with eGFR between 60-105 ml/min per 1.73 m(2), but increased at lower levels. Hazard ratios at eGFRs of 60, 45, and 15 ml/min per 1.73 m(2) were 1.03, 1.38 and 3.11, respectively, compared to an eGFR of 95, after adjustment for albuminuria and cardiovascular risk factors. Log albuminuria was linearly associated with log risk for all-cause mortality without thresholds. Adjusted hazard ratios at albumin-to-creatinine ratios of 10, 30 and 300 mg/g were 1.08, 1.38, and 2.16, respectively compared to a ratio of five. Albuminuria and eGFR were multiplicatively associated with all-cause mortality, without evidence for interaction. Similar associations were observed for cardiovascular mortality. Findings in cohorts with dipstick data were generally comparable to those in cohorts measuring albumin-to-creatinine ratios. Thus, lower eGFR and higher albuminuria are risk factors for all-cause and cardiovascular mortality in high-risk populations, independent of each other and of cardiovascular risk factors.
</p>
},
  year = {2011},
  journal = {Kidney International},
  volume = {79},
  edition = {2011/02/11},
  number = {12},
  pages = {1341-1352},
  isbn = {1523-1755 (Electronic)0085-2538 (Linking)},
  note = {the Chronic Kidney Disease Prognosis ConsortiumKidney internationalKidney Int. 2011 Jun;79(12):1341-1352. Epub 2011 Feb 9.},
  language = {Eng},
}